摘要
目的研究内镜下组织胶联合聚桂醇治疗胃静脉曲张出血的排胶规律,评价其疗效及安全性。方法搜集该院2010年8月-2014年2月因肝硬化伴胃底静脉曲张破裂出血行内镜治疗的患者资料。组织胶联合聚桂醇治疗组（GIS组）患者101例,组织胶治疗组（Histoacryl组）患者70例,均于术后1周、2周、1个月、2个月、3个月、6个月、9个月、12个月及12个月以上对患者进行内镜随访,观察比较两组患者排胶规律和胃底静脉曲张治疗疗效。结果 GIS组术后2和3个月排胶患者比例较高,分别为33.3%和35.7%。Histoacryl组术后1和2个月排胶患者比例较高,分别为45.5%和23.8%。两组患者排胶形态与血管解剖结构相近,排胶颜色各异。排胶多发生在术后1～3个月,多在1年内排胶结束,胶体完全排出时间无明显规律可循。两组患者最早排胶时间比较无明显差异,各随访期排胶率（排胶患者例数/随访患者例数）比较差异无显著性,GIS组在缓解及消除GV方面疗效优于Histoacryl组（P〈0.01）。两组患者术后主要并发症为排胶合并溃疡、排胶引发出血。两组患者排胶再出血时间比较,GIS组早于Histoacryl组。排胶再出血率比较、溃疡发生率比较差异无显著性,所有入组患者均未发生异位栓塞等严重并发症。结论内镜下组织胶联合聚桂醇治疗胃底静脉曲张的疗效优于单纯组织胶,联合治疗不增加术后排胶出血机会,但可使术后排胶再出血时间提前。
【Objective】To study the extrusion rule of glue after endoscopic tissue adhesive combined with lauromacrogol injection for gastric variceal bleeding and evaluate the efficacy and safety. 【Methods】The clinical data of patients who had a history of gastric varices bleeding caused by liver cirrhosis and endoscopic treatment were collected from August 2010 to February 2014. 101 cases were treated with tissue adhesive combined with lauromacrogol（GIS group）, and tissue adhesive（Histoacryl group） 70 cases. The patients were followed up in weeks 1and 2,months 1, 2,3,6, 9, year 1. The extrusion rule of glue and improvement of gastric varices was analyzed by endoscopy in the two groups. 【Results】In GIS group, the glue ratio was 33.3% in month 2, and 35.7% in month 3. In histoacryl group, the glue ratio was 45.5% in month 1, and 23.8% in month 2. The glue clumping shape was correlated with anatomic structure of vessel, and with assorted colors. The glue was extruded into the lumen in one to three months. The glue was eliminated within one year. The ending time of extrusion has no rule to follow. The efficacy was significantly better in the GIS group than in the Histoacryl group（ P〈0.01）. The main complication is re-bleed-ing and ulcer resulting from extrusion. The mean time to rebleeding resulting from extrusion in the GIS group（41.11±23.57） d was shorter than that in the histoacryl group（69.80±26.67） d（ P〈0.05）.【Conclusion】Tissue adhesive combined with lauromacrogol is more effective than histoacryl in improving gastric varices. Although the combination therapy did not increase the rebleeding rate resulting from extrusion, the mean time to rebleeding resulting from extrusion was earlier.
出处
《中国内镜杂志》
北大核心
2015年第7期673-679,共7页
China Journal of Endoscopy
关键词
胃底静脉曲张
组织胶
聚桂醇
内镜治疗
gastric varices
tissue adhesive
lauromacrogol
endoscopic therapy
